Wednesday, March 21, 2012

Clozapine's new ambassador - Claire Danes

I actually wanted to have a nastier title, (two P words came to mind before I came up with "ambassador") but I thought better of it. I wish Claire Danes had at least thought about the implications of what she is doing - but of course, money talks. May the Karma truck eventually drive up to her door and dump a load of excess calories her way.

Here's a look behind the scenes at clozapine, courtesy of David Healy's Mad in America post.

In the latest hit series Homeland Claire Danes plays Carrie Mathison a CIA agent with bipolar disorder taking Clozapine. She takes the drug to prevent herself tipping over into frank paranoia in a world where being paranoid is necessary for survival.

Anyone who knows anything about Clozapine knows Claire Danes is definitely not on it – she would not be as slim and svelte as she is if she were taking it. Weight gain is something Evident about clozapine that stands in contrast to the Evidence showing no weight gain that companies have gone out of their way to produce for Clozapine and related drugs like Zyprexa and Seroquel (see False Friends).

The question is what does Claire Danes know about Clozapine and should she get paranoid rather than just play the paranoid? As an actress is she killing people playing the part she plays? Is there anything else Evident about Clozapine being hidden by the Evidence?

Clozapine began life in 1958. It was given to the world’s leading psychopharmacologist Pierre Deniker to assess. At the time the neuroleptic/antipsychotic group of drugs was regarded as very safe. Several of Deniker’s patients died on Clozapine and startled by the number and range of deaths he said it was Evident that it should not be developed.

The company who made Clozapine (Wander) paid no heed to him; business and clinical evidence are two different things. Clozapine’s development continued even after Wander was taken over by Sandoz. Then in 1975 a series of deaths on Clozapine following drops in white blood cell counts happened in Finland. Clozapine was removed from markets in Europe and never made it to the US – Homeland Security (aka the FDA) intervened.

But it re-emerged in 1988 in the United States, in part because of efforts within Homeland Security. The history of clozapine’s return has been spun and respun – see The Creation of Psychopharmacology – in the course of which a myth has been created that clozapine is more effective than other antipsychotics (very important for someone on whose wits the fate of America depends) even though head to head trials in first episode psychoses show clozapine to be no better than older drugs like chlorpromazine.

8 comments:

I went to London today to give evidence about recovery to the Schizophrenia Commission (get me!) and the chair, Sir Robin Murray, cited Clozapine as being the only really effective anti-psychotic in a study he had done. I wish I had read your post earlier today - then I could have pointed everyone present to it.

I did get my bit for the cause - did more than my share of talking in fact, and really enjoyed it. I am thoroughly amazed at what I am able to do these days - a room full of people was my worst nightmare for many years, and today I was there holding court!

Clozapine is not merely oversold, there is nothing special about it, but it does have major health implications in the long run. I'm reprinting my comment on the Healy post below. What I didn't add was that from day 1, the head of the program Chris was in, was saying how great clozapine was. Pretty soon everybody appeared to be on it. Was it just coincidental that Novartis, the manufacturer of clozapine, is headquartered in the country where we live? Everybody these days seems to think that clozapine is like insulin for diabetes and that it's the best thing going. Wrong, wrong, wrong. Wait till the drug companies finally start getting more products in their pipeline and we'll start hearing less and less about how good clozapine is. Congratulations on your testimony!

"I would like to address what you wrote (and so many believe) about clozapine being considered a drug of last resort. This is not true to my experience. There is so much chicanery surrounding psychopharmacology and other aspects of treatment for psychosis that is it hard to get at the truth of why these drugs are given and to whom they are given. My son was on Rispirdal in Toronto and then switched to Abilify when he moved home (to a different country and a different method of treatment) He wasn’t very long enrolled in a hospital outpatient psychiatric program at home when the doctors began extolling the benefits of clozapine, and we were urged to consider this option. It is absurd to think that someone twenty years old, who has only been on a couple of antipsychotics, is considered “chronic.” We resisted putting him on it for about a year, until the doctors finally wore us down. (I noticed that just about everybody in the same program as my son was on clozapine, not matter what their diagnosis. They even had what I refer to as a clozapine smile.) When I finally decided I wanted my son out of the program and off all medications, I approached a different psychiatrist who told me she had never heard of anyone getting off clozapine successfully. I was frantic when I heard that.

Changing the subject slightly, I thought electroshock, as with clozapine, was supposed to be a treatment of last resort. Apparently not so. My son got very depressed for the first time ever (or since) after he was admitted to hospital for first episode psychosis. The doctors wanted to give him electroshock. He had only been depressed about a week and yet electroshock was going to be administered if he didn’t snap out of it on his own. My husband and I, like my son, were treatment naive at that point. We didn’t know the controversy surrounding electroshock, and would have gladly signed, had my son not snapped out of it. My strong hunch is that the hospital does this sort of thing because it has a captive pool of treatment naive relatives who will gladly allow itto get on with their experimenting on first episode patients. (Ed. note, I changed this last sentence because I flubbed it in my original comment.)

I quite agree. Although I liked Claire Danes's performance, her portrayal of bipolar disorder seemed too simplistic with its implication that her drug was somehow making it possible for her to function ways she'd be incapable of otherwise. The 'mental illness' theme would have been more interesting if the character were shown as someone who refused medication and approached her life with her full energies and liabilities, rather than someone who depended on a medication that is well known for its debilitating effects. It would have been both more accurate and more empowering. It is, in fact, possible to function without medications but it takes discipline and devotion. Breakdown under extreme stress may still occur. That's what I saw in Danes's character and I wish they had simply left the clozapine out of the equation. Thanks for highlighting this show and its shortcomings.

Yes, the mantra these days is when all else fails, clozapine works wonders. I've never seen the show, but it's sure a tip-off that (a) the character is employed (if she needs a drug of last resort, I doubt that would be the case; and (b) she's not fat.

Monk is a show I like to watch, and one of the many things I like about it is that the character wants to manage his life without meds. The episode where he actually tries them is hilarious! He becomes manic.

I went to the Schizophrenia Commission event in Manchester in February 2012 and one of the speakers Shon Lewis was shamefully promoting use of clozapine as better than all the other antipsychotics. He said patients "feel better". He was talking about evidence from the UK Cutlass study and said that clozapine reduces symptoms best, but what he failed to mention was that clozapine does not improve quality of life.

I was forced to take clozapine against my will under a section when I did not even have psychosis. The side effects made me suicidal. I hated the weight gain and the sedation was awful you could not function.I experienced anhedonia and lack of motivation. It was such a powerful drug it inhibited my thinking processes such that I could barely speak. I knew that when I eventually was to be released from hospital I knew I would want to stop taking clozapine as otherwise I would have killed myself. However even reducing clozapine very slowly I experienced a severe withdrawal psychosis when I had never experienced psychosis before. As well as the severe side-effects of clozapine the risks of a severe withdrawal psychosis were the main reasons I did not want to be forced to take clozapine.

I would like to give a link to an article about clozapine which says that "adverse effects and death are common causes of clozapine discontinuation"

Anon -Thanks for sharing the link with us. I would like all those researchers and doctors who make statements about clozapine, to actually go on clozapine and then write about how good and "effective" it is....Rossa

Sorry for the delay in replying. Rossa did tell me you had replied to my comment here,and I meant to write back immediately, but it slipped my mind for a bit. Thank you for your information about clozapine - although some of this stuff I could do without knowing (if you understand what I mean!)

Some of the information about medication is just so grim it makes you start to wonder why on earth it is prescribed - I am eternally grateful that I am not dependent on it and so sorry for those who are.

Well done for getting yourself off the clozapine - Will is right, it is possible to manage without medication, but it helps if other things in life are going right - if you have sufficient stability, support and so on. As for discipline and devotion, these are necessary qualities for so much of life - I am currently battling an addiction to crisps (potato chips) and realise that I am weaker-willed than I would wish!

In which studies was Clozapine shown to be not superior in disease remission than other drugs? All the studies I had read have shown superior efficacy It is slightly more risky as far as SJS but that is still rare. Clozapine differs from normal neuroleptics in that also acts as a Glycine transporter blocker which allows dysfunctional NMDA receptors to work more effectively. There is some interesting research on other GLY transporter inhibitors such as the natural amino acid glycine. You may find it interesting. It is also go to note that there is not lethal dose for glycine treatment.